January 1, 2018 the Department of Transportation will be testing truck drivers for 4 additional synthetic opiods. The testing will include pre-employment and post-accident screening. The Medical Review Officer (MRO) will test for Hydrocodone, Hydromorphone, Oxymorphone, and Oxycodone. These synthetic opiods are to manage pain, but are highly addictive. It is a crisis in the United States, and the DOT is taking measures to help insure the safety of the public. The problem has many faces, but the biggest hurdle for the MROs is that these medications, in most cases,are prescribed by a doctor. The MRO will have to make a determination that can affect the future of the driver. Excessive use can cause decreased reaction time and sleeplessness. There will be a fine line between legitimate pain management and drug abuse.